96. Would you like to say anything by way of
introduction?
(Mr Thompson) Not particularly but we are very keen
to look at the complaints procedure as a whole. I know that most
of your discussions up to this point have been concentrated around
primary care and the out-of-hours service. I suspect that it may
be more appropriate if you pursue those and perhaps widen it out
to the broader complaints procedure later on, if that is in order.

97. We will ask questions all over the place.
First, and you have heard the previous session, does not the Department
of Health have a responsibility in this matter, too? Here was
an out-of-hours service serving a quarter of all GPs in the country
and yet it turns out it could have been operating in this way
with these consequences with no effective monitoring of what it
was doing. What is the Department's responsibility in this?
(Mr Thompson) It might be appropriate at this stage
to ask David Carson to describe some of the work that has been
going on in the whole area of out-of-hours service.
(Mr Carson) I was commissioned by the Department in
March last year to carry out a review of GP out-of-hours services,
which I did with a small team. Included in the remit of the review
was to look at the potential to set quality standards for all
GP out-of-hours services, including those provided by commercial
deputising services, GP co-operatives, GP rotas and GPs who undertake
to do their own on-call for their own lists. We reported to the
Department in September of last year in the report on basic standards
for patients in partnerships with merged care. The Department
of Health has adopted those recommendations that we made in relation
not only to the quality standards but to the mode of service,
the commissioning and planning of the service and the accountability
of providers of out-of-hours services. The Department is looking
forward to implementing the recommendations and I am currently
working on implementing those recommendations.

98. Tell us in a nutshell how these recommendations
would remove the kinds of problems that we identified in these
cases.
(Mr Carson) What we have laid out is the system, a
model of service, which is supported by a set of quality standards.
One of the principles that sits behind those quality standards
is the early clinical assessment of the patient's call as soon
as he enters the system. If the patient lifts the telephone, we
are recommending that the patient only makes one telephone call,
that he does not have to re-dial, and we have set out standards
that the patient's call will be answered in a certain time and
will be assessed by a clinician. We have recommended that 90 per
cent of calls are assessed within 20 minutes and 100 per cent
in 30 minutes.

99. So it is not the initial call going to the
clinician but, as we have heard from previous witnesses, it will
be referred to a clinician?
(Mr Carson) Yes, it will be referred to a clinician
within those times. We have also set standards which describe
the time in which the organisation should be able to identify
those conditions which may be life-threatening and require a much
more urgent response than the 20 or 30 minutes' assessment time.
We are really building on systems that already exist within NHS
Direct or within ambulance services so that lay operators can
use a decision algorithm to prioritise and identify those calls
that require an immediate ambulance response.